According to the World Health Organization (WHO), health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. In a world where the number of children that die before reaching the age of 5 years in the African continent is eight times higher than their European counterparts, it is not enough to define health on its own. Inequality in health is defined as the preventable and unacceptable differences that are caused by the economical, political, denominational, occupational, religious, and cultural reasons and by the inadequacies in accessing health services between the individuals and different sections of the society. The prevalence of violence on women by their husbands exceeds 40% in Southeast Asian and African countries; 804,000 deaths occur worldwide because of suicide, and one out of three people cannot work because of an occupational disease or accident. Thus, additional definitions need to be made to the notion of health inequality while discussing health [1]. Social determinants of health (early childhood development, education, employment and working conditions, income and social status, social and physical environments, social support network, life style, personal health practices and coping skills, gender and social gender, culture, and access to qualified health services) create differences in the health of individuals and societies, and the conditions that people live and die in are determined by the political, social, and economical systems [2]. A large number of workers (approximately 2.3 million) die each year worldwide, 350,000 because of occupational accidents and approximately 2 million because of occupational diseases [3]. Occupational health is defined as an area of application in which the effects of work life on health are investigated. A public health approach, using the notion of occupational health represents a partial understanding of health, leads to defining workplace and work life as outside of public health. The reasons for that are that citizens are seen not as workers but as consumers and that work life is moved out of the healthcare field. This causes occupational health to detach from public health when organizing healthcare services [4]. According to the International Labor Organization (ILO) and WHO, occupational accidents are defined as unplanned occurrences, often resulting in personal injuries; damages to machines, tools, and equipment; and halting the production
Background Evidence-based reviews have found that evidence for the efficacy of respiratory protective equipment (RPE) in the management of occupational asthma (OA) is lacking. Aims To quantify the effectiveness of air-fed RPE in workers with sensitizer-induced OA exposed to metal-working fluid aerosols in a car engine and transmission manufacturing facility. Methods All workers from an outbreak of metal-working fluid-induced OA who had continuing peak expiratory flow (PEF) evidence of sensitizer-induced OA after steam cleaning and replacement of all metal-working fluid were included. Workers kept 2-hourly PEF measurements at home and work, before and after a strictly enforced programme of RPE with air-fed respirators with charcoal filters. The area-between-curve (ABC) score from the Oasys plotter was used to assess the effectiveness of the RPE. Results Twenty workers met the inclusion criteria. Records were kept for a mean of 24.6 day shifts and rest days before and 24.7 after the institution of RPE. The ABC score improved from 26.6 (SD 16.2) to 17.7 (SD 25.4) l/min/h (P > 0.05) post-RPE; however, work-related decline was <15 l/min/h in only 12 of 20 workers, despite increased asthma treatment in 5 workers. Conclusions Serial PEF measurements assessed with the ABC score from the Oasys system allowed quantification of the effect of RPE in sensitized workers. The RPE reduced falls in PEF associated with work exposure, but this was rarely complete. This study suggests that RPE use cannot be relied on to replace source control in workers with OA, and that monitoring post-RPE introduction is needed.
BackgroundRemoving exposure to the causative agent in workers with occupational asthma or hypersensitivity pneumonitis is the main goal. The effectiveness of Respiratory Protective Equipment (RPE) in sensitised workers with usual exposures in their workplace is not known. We aimed to assess changes in serial peak expiratory flow (PEF) in workers with sensitisation to metal working fluid before and after the introduction of RPE.MethodsWorkers who had been requested to keep 2-hourly PEF measurements before and after the introduction of RPE at a particular engine manufacturing plant were searched for on the Oasys PEF database. Those who had completed a minimum of 1 week before and after the introduction of RPE and had a positive area between curves (ABC) score for occupational effect from Oasys analysis (≥ 15 L/min/hr) on either record were included. All PEF measurements were made outside the working area where the RPE could be removed. Workers who remained symptomatic after cleaning and replacement of the metal-working fluid were only allowed to continue work if they complied with the strict use of respiratory protective equipment (RPE) using powered filtration and external changing facilities.Results19 workers fulfilled the inclusion criteria. The mean ABC score before RPE use was 27.85 L/min/hr (SD 17.69) and after RPE use was 19.65 L/min/hr (SD 22.77) showing a mean overall decrease of 8.20 L/min/hr (SD 28.60). 9 workers (47%) no longer showed an occupational effect on their PEF record once RPE was instated, 7 workers continued to show an occupational effect and 3 workers showed a new occupational effect which was not present before RPE use.ConclusionSerial PEF measurements assessed with the ABC score from the Oasys system allowed quantification of the effect of RPE in sensitised workers. The RPE abolished falls in PEF associated with work exposure in 47% of workers, the remaining 10 workers had significant falls in PEF despite rigorously applied RPE. RPE should still remain a last resort in the hierarchy of control for occupational health.
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